“Go Get Tested” Gonorrhoea and
Chlamydia Initiative
TO:
Chair and members of the Board of Health
MEETING DATE:
December 7, 2016
REPORT NO:
BH.01.DEC0716.R24,
PREPARED BY:
Rosalyn LaRochelle Manager, Clinical Services
APPROVED BY:
Rita Sethi Director, Community Health and Wellness
Pages: 7
Original Signed Document on File
SUBMITTED BY:
Dr. Nicola J. Mercer, MD, MBA, MPH, FRCPC
Medical Officer of Health & CEO
Recommendations
It is recommended that the Board of Health:
1.
Receive this report for information.
Key Points
Requesting testing for sexually transmitted diseases can be embarrassing. As adults re-enter
the dating scene, easy access to testing and counseling is essential as rates of both chlamydia
and gonorrhea are on the rise. Of particular public health concern is the detection and treatment
of Gonorrhea as treatment options are becoming limited due to antibiotic resistance.
Go Get Tested is an easy, anonymous on-line option for chlamydia and gonorrhea testing. By
downloading a lab requisition and providing a urine sample at a local Life Labs, testing can
occur without the need for direct interaction with a family physician. Follow-up counseling and
treatment to positive tests is provided by nurses specializing in sexually transmitted infections.
Discussion
Gonorrhea
Gonorrhea rates continue to rise both internationally and within Canada. Locally, rates of
gonorrhea doubled from 2013 to 2014, dropped slightly in 2015 and are showing an increase
over 2014 in 2016. In 2013, the Ontario testing and treatment guidelines for gonorrhea were
changed due to increasing antibiotic resistance. Following the release of the guidelines there
was an initial improvement across the province in resistance patterns. More recently, however,
there has been an increase in the number of cases in the province with antibiotic resistance.
There have been no treatment failures reported within Wellington-Dufferin-Guelph Public Health
(WDGPH).
Gonorrhea is the second most commonly reported sexually transmitted disease in Ontario. It is
a bacterial infection that is most commonly spread through vaginal, anal and oral sex, but can
also be transmitted from an infected mother to her baby during childbirth.
If left untreated, gonorrhea can lead to a number of complications in women (eg. Pelvic
inflammatory disease, infertility, ectopic pregnancy, chronic pelvic pain) and in men (eg.
epididymo-orchitis, and infertility).1
A review of the local gonorrhea infections of year to date data for 2016:



There is an increase in cases for individuals 15 years of age and older (Table 1)
Increase in presence in rural areas and Dufferin County.
Majority of cases are male, however, the number of cases seen in women is increasing
over the last year. (Table 2)
Table 1 (based on information up to November 14, 2016)
Number of Cases
Lab-Confirmed Cases of Gonnorrhea by Age Group,
WDGPH 2011-2016
80
70
60
50
40
30
20
10
0
50+
25-49
20-24
15-19
2011
2
24
5
0
2012
4
26
8
0
15-19
2013
6
14
7
1
20-24
“Go Get Tested” Gonorrhoea and Chlamydia Initiative
2014
7
44
15
1
25-49
2015
5
43
14
1
2016
3
43
20
8
50+
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Table 2 (based on information up to November 14, 2016)
Confirmed Gonorrhea Cases by Gender,
WDGPH 2011-2016
41.9%
58.1%
2011
44.7%
55.3%
2012
57.1%
42.9%
2013
Female
63.6%
67.2%
36.4%
32.8%
2014
2015
54.8%
45.2%
2016
Male
Risk factors for gonorrhea continue to be:



Sex with opposite sex
No condom use
New partner in past 2 months
Chlamydia
Chlamydia is most common reportable sexually transmitted infection and is often asymptomatic
which can result in delayed diagnosis and treatment. The number of chlamydia infections,
similar to gonorrhea, also continues to rise. In WDGPH from 2013 to 2015 the number of
infections increased locally by 37%. As of November 2016, WDGPH has experienced a further
17% increase in rates from 2015.
If left untreated, chlamydia can lead to epididymo-orchitis in males, and pelvic inflammatory
disease, ectopic pregnancy, infertility, and chronic pelvic pain in females.2 Chlamydia is
treatable with antibiotics and unlike gonorrhea is not at risk of losing treatment options due to
resistance.
A review of the local chlamydia infections of year to date data for 2016:


Largest number of cases occur in people under the age of 30 years old. (Table 3)
Majority of cases are remain consistently female. (Table 4)
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Table 3 (based on information up to November 14, 2016)
Number of Cases
Lab-Confirmed Cases of Chlamydia by Age Group,
WDGPH 2011-2016
800
700
600
500
400
300
200
100
0
50+
25-49
20-24
15-19
2011
12
481
158
0
2012
16
377
185
7
2013
9
300
178
21
15-19
20-24
2014
5
281
340
27
25-49
2015
14
250
377
62
2016
14
206
327
116
50+
Table 4 (based on information up to November 14, 2016)
Confirmed Chlamydia Cases by Gender,
WDGPH 2011-2016
30.7%
34.4%
38.5%
34.4%
35.9%
39.2%
69.3%
65.6%
61.5%
65.6%
64.1%
60.8%
2011
2012
2013
2014
2015
2016
Female
“Go Get Tested” Gonorrhoea and Chlamydia Initiative
Male
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Both chlamydia and gonorrhea cases are on the rise in Wellington-Dufferin-Guelph and the
exact cause for this increase is unknown. Based on the data, lack of condom use; multiple or
new sexual partners within six months of diagnoses and sex with the opposite sex are the
majority of risk factors associated with these infections. Despite recommendations for annual
chlamydia and gonorrhea screening, far too many people are not tested, and therefore don’t
know they are infected, increasing the spread of diseases. 9 Additionally, middle aged and older
adults are re-entering the dating scene and may not know they should or how to get tested for
sexually transmitted infections.10 Finally, diseases such as Human Immunodeficiency Virus
(HIV) and Acquired Immunodeficiency Syndrome (AIDs) are considered a chronic and
manageable disease in some populations reducing condom use in these populations. 10
Education, public awareness campaigns, increased access to testing are all strategies that
public health can use to help detect and treat sexually transmitted infections such as chlamydia
and gonorrhea. Additional surveillance and assessment is required to further understand the
increase in these infections moving forward.
Go Get Tested
Requesting counseling and testing for sexual transmitted diseases from primary care providers
may be embarrassing, particularly for adults. Adults are open to discussing sexual health issues
with their primary care provider if the provider initiates the conversation, however, studies show
that providers don’t initiate the conversation often enough.
Wellington-Dufferin-Guelph Public Health began an initiative, Go Get Tested, to encourage
sexually active people to get tested for gonorrhea and chlamydia without first seeing a primary
care provider. Go Get Tested is an easy, anonymous way to get tested for gonorrhea and
chlamydia. An on-line lab requisition is available to print from the public health website and take
to a local Life Labs, where an Ontario Health card and a small urine sample is all that is required
for these tests. Results are available by phone 2 weeks later. If the test is positive, a nurse from
public health who specializes in addressing sexually transmitted diseases will provide
counseling about the infection and arrange treatment.
The Go Get Tested model was started in 2015 and is formatted after Ottawa Public Health’s
“Get Tested. Why Not” campaign. Advertising of Go Get Tested has mainly been with high
school and university students, but there has been no restriction as to who can be tested under
this model. As of September 2016, 11% of the 89 tests performed came back positive for either
gonorrhea or chlamydia. Age range of positive cases has been from age groups 15-19 years to
45-49 years. As many adults re-enter the dating scene, access to testing becomes more
important. Starting late fall 2016, Wellington-Dufferin-Guelph Public Health will advertise the Go
Get Tested initiative to the adult and older adult population in our areas.
As there are no LifeLab offices in North Wellington, Public Health will offer a similar service.
People living in North Wellington can bring a downloaded requisition, along with their health
card, to the Public Health office. They will be given a urine bottle to provide a sample which will
be forwarded to a formal lab for processing on behalf of the client. Clients with positive results
will be contacted by an experienced sexual health nurse who will ensure counseling and
treatment are provided. Residents of North Wellington will be able to get testing without having
to travel or provide personal details to their family physician, making this a more comfortable,
discrete option for those who may not have transportation, or may know their local health care
provider personally.
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Conclusion
Chlamydia and gonorrhea are both sexually transmitted infections that continue to be on the
rise. While chlamydia is easily treated, gonorrhea is showing antibiotic resistance and has
limited treatment options. Preventing the spread of infection of these sexually transmitted
diseases is a primary role of public health in Ontario.
Requesting sexual health counseling and treatment by a family physician may be embarrassing,
particularly for an adult population who may be re-entering the dating scene. Providing the
public with discrete access to testing for the most common sexually transmitted infections helps
to diagnose and treat infections while reducing the spread of disease. Easy access to testing
and treatment by downloading a lab requisition and providing a urine sample at a local lab make
the Go Get Tested initiative an attractive alternative to the traditional approach to testing and
treatment.
Ontario Public Health Standard
Sexual Health, Sexually Transmitted Infections, and Blood-borne Infections (including HIV):

To prevent or reduce the burden of sexually transmitted infections and blood-borne
infections
WDGPH Strategic Direction(s)
Check all that apply:
Building Healthy Communities
We will work with communities to support the health and well-being of everyone.
Service Centred Approach
We are committed to providing excellent service to anyone interacting with Public Health.
Health Equity
We will provide programs and services that integrate health equity principles to reduce or eliminate health
differences between population groups.
Organizational Capacity
We will improve our capacity to effectively deliver public health programs and services.
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Health Equity
Go Get Tested opens options for the detection and treatment of both chlamydia and gonorrhea
to people who are uncomfortable speaking about their sexual health to a family physician.
Providing an alternative formation of the Go Get Tested option in the Mt Forest area ensures
that people living in all areas of WDG public health area have access to this service.
Appendices
None.
References
1.
Public Health Agency of Canada: Canadian Guideline for Sexually Transmitted Diseases,
July 2013: http://www.phac-aspc.gc.ca/std-mts/sti-its/cgsti-ldcits/assets/pdf/section-5-6eng.pdf
2. Public Health Agency of Canada: Canadian Guideline for Sexually Transmitted Diseases,
July 2013: http://www.phac-aspc.gc.ca/std-mts/sti-its/cgsti-ldcits/section-5-2-eng.php
3. Tillman JL, Mark HD. HIV and STI testing in older adults: an integrative review. Journal of
Clinical Nursing.2015; 24: 2074-2095.
4. Nusbaum MRH, Singh AR, Pyles AA. Sexual Healthcare Needs of Women Aged 65 and
Older. J Am Geriatr Soc. 2004; 52; 117-122.
5. Morton CR, Kim H, Treise D. Safe Sex After 50 and Mature Women’s Belief of Sexual
Health. The Journal of Consumers Affairs.2011; Fall: 372-390.
6. Gott CM. Sexual activity and risk-taking in later life. Health and Social Care in the
Community. 2001; 9(2): 72-78.
7. Balfe M, Brugha, O’Donovan D, O’Connell EO, Vaughn D. Triggers of self-conscious
emotions in the sexually transmitted infection testing process. BMC Research Notes. 2010;
3:229. Available from: http://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-3229
8. Baker JR, Arnold-Reed DE, Brett T, Hince DA, O’Ferrall I, Bulsara MK. Perceptions of
barriers to discussing and testing for sexually transmitted infections in a convenience
sample of general practice patients. Australian Journal of Primary Health. 2013; 19; 98-101.
9. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance
2014. Atlanta: U.S. Department of Health and Human Services; 2015. Available from:
http://www.cdc.gov/nchhstp/newsroom/2015/std-surveillance-report-press-release.html
10. Relich S, Taylor M, Konkin K. Chlamydia, gonorrhea and syphilis on the rise: Is Tinder to
blame? Healthy Debate; June 9, 2016. Available from:
http://healthydebate.ca/2016/06/topic/chlamydia-gonorrhea-rise-tinder-blame
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